Resnick Steven MD

Information may not be reliable

Find out about Dr. Steve Resnick, the Coordinator of this Website, and his Psychiatric Practice.

Seeking Treatment for Depression: What to Expect The Benefits of Aerobic Exercise
What is Panic Disorder? Advice for Quitting Smoking Depression Co-Occurring with a Medical Illness Obsessive Compulsive Disorder
Links to Other Sites

Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is characterized by several key features starting with obsessions, which are unwanted ideas or impulses that continually well up in the mind of the person with OCD: for example, the persistent fear that harm may come to self or a loved one or an excessive need to do things correctly or perfectly. In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions, of which washing and checking are the most common.
In many instances, people with OCD show a range of insight from recognizing that their obsessions and compulsions are senseless to strong belief in their validity. Many OCD victims are able to control their symptoms for periods of time. When their resistance weakens they are plagued with shame and secrecy in an attempt to hide their disorder.
OCD can be successfully treated by the use of medication or behavioral therapy or both. Which therapy to use should be decided by the individual patient in consultation with his or her therapist.
Source: The National Institute of Mental Health (NIMH) , a federal agency that supports mental health research.
Return to Short Takes Contents

Phobias aren't just extreme fear; they are irrational fear. Phobias occur in several forms: specific phobias, social phobias and agoraphobia.
A specific phobia is a fear of a particular object or situation. For example, dogs, closed-in places, heights, escalators, tunnels, highway driving and flying are a few of the more common fears. Specific phobias strike more than 1 in 10 people and no one knows what causes them, though they seem to run in families and are a little more prevalent in women.
Social phobia is an intense fear of becoming humiliated in social situations. Although this disorder is often thought of as shyness, the two are not the same. The dread of a social event can begin weeks in advance, and symptoms can be quite debilitating.
Agoraphobia, which often accompanies panic disorder, is a fear of being in any situation that might provoke a panic attack, or from which escape might be difficult if one occurred.
If the object of the fear is easy to avoid, people with phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation. About 80% of people who suffer from phobias find relief from their symptoms when treated with therapy and medications.

An estimated one in ten Americans suffer from depression, an illness that affects both physical and mental well-being. Often chronic in nature, depression can be triggered by adverse life circumstances or occur simply "out of the blue." Frequently, a combination of genetic, psychological and environmental factors contribute to the onset of depression.
Fortunately, depression is highly treatable. Years of research have yielded medications and therapies that can relieve most depressive illnesses.
Symptoms of depression include: a sad, discouraged mood; feelings of guilt, emptiness, worthlessness, helplessness; persistent pessimism; loss of interest in work, hobbies, social life, sex; difficulty making decisions; lack of energy; suicidal thoughts; restlessness; disturbed sleep; irritability; changes in appetite or weight; and desolate dreams. While everyone has these symptoms occasionally, anyone experiencing several of them should be professionally evaluated.
If you think you may be suffering from depression, your physician can discuss your symptoms with you and guide you to the appropriate source of treatment.

The human spine, or backbone, is made up of small bones called vertebrae, that are stacked on top of each other to form a column. The vertebrae are separated by cushions called discs, and are held together by ligaments. Muscles are attached to the vertebrae by bands of tissues called tendons. Openings in the vertebrae form a long hollow canal through which the spinal cord runs down from the base of the brain. Nerves from the spinal cord branch out and leave the spine through the spaces between the vertebrae.
The lower part of the back holds most of the body's weight, so even a minor problem in this area can cause pain when a person stands, bends or moves around. The exact cause of low back problems can be found in very few people. Most times, the symptoms are blamed on poor muscle tone, muscle tension or spasm, ligament or muscle tears, sprains, or joint problems. Sometimes nerves from the spinal cord can be irritated by slipped discs, causing buttock or leg pain.
People at greater risk for low back problems include those who are in poor physical condition, or who do work involving heavy labor or long periods of sitting or standing. Emotional stress and extended periods of inactivity may intensify back pain symptoms.
For back pain that is severe, lasts more than a few days, or keeps you from doing things, a visit to your health care provider is recommended.

High blood cholesterol is a serious problem: it is a risk factor for heart disease, the number one killer of both men and women in the U.S.
Two specific kinds of blood cholesterol are low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL cholesterol, sometimes called "bad" cholesterol, causes cholesterol to build up in the arteries. Too much LDL in the blood increases the risk of heart disease. In contrast, HDL, or "good" cholesterol helps the body get rid of the cholesterol in the blood, so too little HDL increases heart disease risk.
Accepted guidelines recommend that adults have their cholesterol levels checked at least once every 5 years, to measure total cholesterol as well as LDL and HDL levels. A total cholesterol level of less than 200 mg is desirable, while 240 mg or above is considered high. A reading of 200-239 mg is borderline, and may be treated as high if HDL is low or if other heart disease risk factors are present. HDL should be 35 mg or higher, while LDL should be less than 130 mg.
Factors that influence cholesterol levels include dietary intake of fat and cholesterol, obesity, lack of physical activity, genetic makeup, age and gender. It is best to modify behaviors that can affect these factors whenever possible, by choosing a sensible diet, exercising and maintaining a healthy weight.

Safety Tips: Homes with Children
More children die in home accidents than from all childhood diseases combined. Careful supervision is essential. The U.S. Consumer Product Safety Commission offers suggestions for eliminating common household dangers.
Keep medicines, cleaners, paint solvents and other chemicals locked up, out of sight and reach. Keep plastic bags and other materials, which can cause suffocation, away from children. Use safety caps on electrical outlets, and unplug appliances when not in use. Keep children away from open windows; screens may not prevent falling. Don't let children play with toys with small, removable parts, which present a choking hazard. Remove free falling lids from toy chests and other containers.
Nursery equipment must be used carefully as well. Check for sturdy construction and stability, and avoid items with exposed fasteners or sharp edges. Always use safety straps. Never leave a child in a playpen with one side down. Never tie pacifiers or other items around a baby's neck. Don't hang objects with string or elastic near cribs or playpens, and keep them out of reach of drapery and blind cords.
Source: U.S. Consumer Product Safety Commission, an independent Federal regulatory agency,which helps keep American families safe by reducing the risk of injury or death from consumer products.

Seeking Treatment for Depression
Treatment for depression should begin with a complete physical and psychological evaluation, reviewing the onset, duration, and severity of your symptoms. You should disclose any alcohol use, drug use or suicidal thoughts. Examination, interviews and lab tests may be used to detect other medical conditions and assess your speech, thought patterns and memory.
Antidepressant medications and psychotherapies are commonly used to treat depression. Recently, two new classes of antidepressants have been introduced which cause fewer side effects: serotonin re-uptake inhibitors and bupropion. Antidepressants have proven to be effective and are not habit-forming. They usually cause only mild, temporary side effects.
Various forms of psychotherapy can relieve depression. Interpersonal therapy focuses on disturbed personal relationships. Cognitive/behavioral therapy explores negative thinking and behavior patterns. Psychodynamic therapy targets internal conflicts thought to be rooted in childhood.
In severe or life-threatening cases, electroconvulsive therapy (ECT) provides an alternative form of treatment.

The Benefits of Aerobic Exercise
Studies show that strenuous physical exertion is no more useful to maintaining fitness than moderate exercise. Walking and other aerobic exercises, done at a pace which makes you breathe a little harder and work up a mild sweat for 30 to 60 minutes, three times a week, will condition your cardiovascular system and strengthen your bones and muscles. Aerobic exercise also helps prevent osteoporosis, slows the buildup of cholesterol plaque in the blood vessels, and improves the functioning of vital internal organs.
Exercise intensity for aerobic conditioning is measured by heart rate. Generally, a good activity level is 70 percent of your maximum heart rate. To calculate this, subtract your age from 220, and multiply that number by .70. However, consult your physician for guidance about your fitness level and the intensity of your exercise program before beginning your workouts.
Dancing, tennis, racquetball, basketball and biking are also good aerobic exercises. Be sure to warm up before and cool down after exercising, and watch for signs of overexertion including dizziness, disorientation, nausea, or pain in the chest, back, left shoulder or left arm.
Source: The U.S. Department of Health and Human Services Administration on Aging

What is Panic Disorder?
Researchers estimate that millions of Americans suffer from Panic Disorder, characterized by "panic attacks," episodes of intense fear and frightening physical symptoms that come on suddenly in the absence of any real threat. Often, they withdraw from everyday situations, not knowing what will trigger another panic attack.
Fortunately, proper treatment can usually relieve panic disorder. The National Institute of Mental Health has found psychotherapeutic medications and cognitive-behavioral therapy to be most effective. However, panic disorder often goes undiagnosed for various reasons: its symptoms mimic those of other ailments; people feel embarrassed to seek help; or patients downplay the emotional component of the attacks which are important for an accurate diagnosis.
Symptoms of panic attacks can include: racing heartbeat; chest pain; difficulty breathing; dizziness; nausea; chills or hot flashes; sweating; shaking; tingling or numbness; distorted perception; fear of dying; and a sense of impending doom. If you think you are experiencing panic attacks, see your physician.

Advice for Quitting Smoking
The addictive nature of nicotine makes quitting smoking a difficult endeavor. Nicotine causes the brain to release chemicals that perpetuate the desire to smoke. The encouraging news, however, is that half of all people who have ever smoked have successfully quit.
Experts recommend three approaches to quitting, which work best when used together: using nicotine patches or gum; seeking support and encouragement for your efforts; and learning to control the urge to smoke. The patch and gum contain nicotine which passes through the skin, curbing nicotine cravings. They can double your chances of quitting. Support and encouragement can be sought through counseling, support groups, self-help materials, family and friends. Ex-smokers are often the best sources of support. Finally, try to avoid events and activities that trigger the desire to smoke.
Organizations that offer information on how to quit smoking include the American Heart Association, American Cancer Society, American Lung Association, National Cancer Institute, and American College of Obstetrics and Gynecology.
Source: The National Institutes of Health, the principal biomedical and behavioral research agency of the U.S. Department of Health and Human Services.

Depression and Medical Illnesses
Having a physical illness can cause you to feel "down" or sad. But if the sadness is severe or long-lasting, there may be an unrecognized link: clinical depression co-occurring with a medical condition. Clinical depression is estimated to occur in up to one-third of medically ill people.
Depression and medical illness may occur together for different reasons: medical disorders may contribute biologically to depression; ill people may become depressed as a psychological reaction to the prognosis, pain and incapacity caused by the illness; or the two illnesses may be unrelated. Depressive symptoms may also develop as a side effect of medication. It is important to discuss your symptoms with your doctor so that an accurate diagnosis can be made.
Treatment of co-occurring depression can have a positive effect on the course of the medical illness, particularly when it improves a person's ability to manage chronic illness such as diabetes and heart disease. In addition, it can significantly enhance an individual's quality of life.

Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by repetitive thoughts and behaviors that are extremely difficult to overcome. Consider Isobel, an intelligent student failing first period biology because she's always late. She awakens before dawn to get to school on time, but spends three hours showering and repeatedly changing clothes, packs and repacks her books until they're in perfect order, and pauses on each step as she walks downstairs. She rushes to school but misses most of first period.
OCD sufferers are plagued by obsessions, which are unwanted, repetitive thoughts, persistent fears, or a need to do things excessively. They attempt to dispel the anxiety of obsessions with ritualistic behaviors called compulsions. Repeatedly washing, checking things, counting and rearranging objects are common compulsions.
Research indicates that more than two percent of Americans have OCD. Medications classified as serotonin re-uptake inhibitors (SRIs) can successfully treat the disorder. SRIs affect the neurotransmitter serotonin, which supports the theory that OCD has a biological basis.

The Baseball Hero

There once was a very young boy who dreamed of being a great baseball player. Like any good athlete, he knew he's have to practice, so he picked up his ball and bat, put on his baseball cap and went into his backyard.
Standing confidently, he threw the ball into the air, and as it came down he swung his bat with all his might. Woosh....He missed. "Strike one." He called out.
Undaunted, he picked up the ball again, threw it into the air, and with determination in his eyes, he swung again. Woosh....He missed again. "Strike two" he murmured.
Knowing that success doesn't always come easily, and with the confidence of youth on his side, he picked up the ball again. He paused this time, made sure his feet were planted firmly, adjusted his cap, and threw the ball into the air again. As it fell from the sky he thought of all his baseball heroes, he thought of all the underdogs that succeeded against the odds, he thought about all the ninth inning comebacks, and he swung one last time at the ball.

Woosh....Plop....The ball fell to the ground. He had missed again. He picked up the ball. With disappointment in his face, and maybe even a hint of a tear in his eye, he started walking back to his house. But then his frown changed into a smile, and his walk turned into a proud strut, and as he got back to his door, he turned to the yard, and proudly shouted "Strike three, you're out!, and I'm gonna be the greatest pitcher there ever was!"

Many people develop depression in the late fall or winter, and improve on their own in the late spring or summer. Until recently, this was often ignored or not recognized as having a seasonal pattern. Now, however, thanks to increased public awareness, many people who had suffered with these problems in the past are now being helped. There are several treatments available now, including treatment using a special "light box".
Problems during the winter can be from two different causes. First, there are depressive symptoms related to psychological or social factors. This includes reactions to the holidays such as loneliness or family conflicts, or a response to other changes in one's lifestyle (such as a landscaper who might be unemployed each winter, or someone getting less exercise during the winter). Even though there may be a "cause" for these symptoms, working with a professional is often helpful.
In this article we will focus on the second type of Winter Blues, which is related to the shortening of daylight in the winter. Many people often blame other factors for their mood, when it may actually be related to light changes. In its more severe form it is known as "Seasonal Affective Disorder" or "SAD". This syndrome effects about 6% of the population, with an additional 14% of people having a milder form. In other words, one in five Americans suffers with some type of decreased functioning, sadness, or other problems, as the season changes to winter.
Recent research has shown that SAD also effects children and adolescents, possibly with almost 50% of children having some changes in mood or behavior associated with wintertime.

SAD is a set of symptoms which recur in a seasonal pattern (usually late fall or winter), and also improve in a seasonal pattern (usually in the spring). People may also have a less severe form of the illness, with milder symptoms ("The Winter Blues"). These symptoms vary from person to person, but most commonly include some of the following:

Children with SAD or the Winter Blues may show very different symptoms, such as: behavior problems, change in energy level, changes in contact with friends, irritability, or problems with grades or school performance. These can be in addition to some of the adult symptoms, or may occur alone.
People often don't realize they have SAD, or they blame the symptoms on other causes, such as laziness, medical problems, social problems etc. This is why it is important for a professional with experience in this area to do an evaluation to determine the cause(s) of the problems.
SAD occurs about four times more often in women than in men, and about 50% of women with this disorder have premenstrual problems which worsen in winter. SAD symptoms typically start in late September, October or November and usually begin to improve in March, April or May. January and February are often the most difficult months. The average length of depression is about five months but varies a lot. Depression in general, and SAD specifically, sometimes runs in families.

Light therapy or "Phototherapy" (photo = light) is a relatively new treatment for SAD or its milder forms.
Typically, someone sits one and a half feet away from a "light box" (a special set of fluorescent lights) for about a half hour each morning. The timing, duration and distance of the lights vary from person to person and should be determined by a knowledgeable professional, and is sometimes adjusted as treatment continues.
While the person is in front of the light they don't have to look directly into the light, and may do things such as read, write, or have breakfast. Many people feel a dramatic improvement in mood within three to four days. The morning light treatments continue throughout the winter, since one often develops problems again if they stop treatments too early in the season.
HOW AND WHY?
How Phototherapy works, and why people get depressed in the winter, is still not clear, but research indicates some probable answers. All living things have internal "biological clocks" which regulate many things such as eating, hormones, menstrual cycles, mating, activity level, and sleep. This biological clock gets "set" by outside factors. One important influence on our internal clocks is the duration, timing, and intensity of sunlight, which changes according to the season. Unfortunately society and its obligations don't necessarily change as well. The time we have to wake up each morning usually stays the same, but our body's clock changes as the time of sunrise changes. This causes a mismatch between our lifestyle schedule and our body's clock (which changes with the seasons). It is this mismatch that can cause mood changes in some people. Also, many animals increase their sleep and slow down their activity levels in the winter, such as a bear hibernating. Some believe SAD depression is similar, being a type of slowing-down.
Phototherapy basically works by using a light box to imitate summer light patterns during the winter. Research shows that giving light treatments in the morning are more effective than in the afternoon or evening. This is probably because morning light is better at resetting our internal clocks. It has also been shown that the intensity of light is very important. The light source must be fairly bright (about the intensity of outdoor sunshine) for it to have an effect.

The Winter Blues and SAD are problems that many people have (one in five, if not more), yet they often go unrecognized and untreated. Luckily, more and more people are becoming aware of these problems and are dramatically improving their lives by getting the proper treatment. Even if SAD or Winter Blues turns out not to be the problem, it is important that symptoms of tiredness, irritability, sleep or appetite changes, loss of interest, or other symptoms mentioned above, are not ignored. If these symptoms develop, a professional evaluation may be indicated. These problems can have many different causes, and can be helped with the right treatment.
the Society for Light and Biological Rhythms : A web site with useful resources for further information about SAD and other Biological Rhythms.
The SunBox® Company: a company which sells light boxes, the site also has useful information about SAD and light therapy (get a discount if you contact Dr. Steve Resnick first!)

Problems With Smoking and the Benefits of Stopping:
Smoking is known to be a true addiction with both psychological and physical addiction components. Smoking increases the risk of many health problems, such as heart disease, stroke, cancers, lung disease, and problems with pregnancy, to name a few.
Many people think that smoking causes physical damage that can't be changed. The good news is that when someone stops smoking, many of these problems can improve dramatically, for example:

After 10 years of abstinence, quitters have 30% - 50% of the risk of lung cancer as compared to smokers.
After just one year of quitting, there is a 50% reduction in the risk of premature coronary heart disease.
Eventually, after quitting, the risk of stroke decreases to equal that of a person who never smoked.

Other problems of smoking include the negative image (it's now considered "gross" rather than "cool"), the inconvenience, the expense, and the problems of second hand smoke on others.
A Strategy for Quitting:
"To cease smoking is the easiest thing I ever did; I ought to know because I've done it a thousand times." - Mark Twain
Most people who quit smoking require several attempts before they are successful. In fact, even though about 70% of smokers want to stop, less than 10% are able to quit successfully each year.
If there have been several failed attempts at quitting, it is important to make a plan that combines several methods into a comprehensive quitting strategy. Smoking is both a biological and psychological addiction, and the best results for stopping come from using behavioral techniques combined with medication, all with professional counseling and supervision.
Behavioral treatments for smoking include:

A smoking diary to pinpoint individual times or situations which effect smoking patterns, and taking specific steps to change
A supervised program to slowly decrease the amount of nicotine by changing the cigarette brand used
The use of multiple support systems, such as friends, family, and outside mail & phone programs (often free)
Anxiety reduction through relaxation techniques

The use of medication can often help smokers stop. In the past there were only nicotine products such as patches or gum, which work by substituting another form of nicotine in place of cigarettes, and then slowly lowering the use of the substitute. Another product is now available, which appears to decrease the actual craving for smoking. This product (Zyban) must be prescribed, and should be used along with a full quitting program.
Often smoking is related to anxiety or other psychological issues. It is important to consider counseling or psychotherapy when trying to make a complete quitting program.
Though quitting can be quite difficult, if one is motivated and willing to use a full program including support, behavior change, counseling or therapy, and medication, we can increase the odds and have a great shot at quitting!

2. Smoking is the single major cause of fires in the United States. .......TRUE.......FALSE

4. Economic consequences of smoking include 16 million dollars in direct medical costs each year in the United States. .......TRUE........FALSE

6. Most smokers gain a significant amount of weight after quitting smoking. .......TRUE........FALSE

9. Smokers need to smoke for many years in large quantities for physical damage to occur. .......TRUE........FALSE

10. Damage to the body due to cigarette smoke is always irreversible. .......TRUE........FALSE

12. If you are not currently experiencing any medical problems, smoking is not physically harmful to you. .......TRUE........FALSE

13. Children of smokers are at an increased risk for upper respiratory tract infections, middle ear infections, asthma, and tonsillitis. .......TRUE........FALSE

14. There are no long-term effects of being exposed to cigarette smoke as a child. .......TRUE........FALSE

15. It is not necessary to quit smoking completely when chewing nicotine gum or using a nicotine patch. .......TRUE........FALSE

16. If you have not been smoking for several months it is safe to have an occasional cigarette. .......TRUE........FALSE

18. Smokers have twice the risk of developing infections after surgery when compared to non-smokers. .......TRUE........FALSE

19. Smokers who quit smoking at least six months prior to having surgery significantly decreases their chances for developing breathing complications. .......TRUE........FALSE

20. The worst dental problems associated with smoking are bad breath and brown teeth. .......TRUE........FALSE

3. True. One-half million Americans die each year of coronary heart disease, of which 30 percent is caused by smoking.

9. False. All smoking is potentially damaging to the body. Genetic risk factors contribute to the amount and type of damage that occurs.

11. False. Many smokers attempt to quit smoking several times before they finally achieve success.

15. False. The nicotine gum and patch were both designed to provide your body with a specific amount of nicotine which is to be tapered down in amount over time. The goal of these products is to ease smokers through the physical withdrawal process. When you use these products in combination with smoking you are actually increasing the amount of nicotine that your body is receiving, as well as its harmful effects.

2. True. One-third of all apartment and hotel fires are caused by smoking. Seventeen percent of private dwelling fires are caused by smoking. The result of these fires is 4,000 injuries and 1,500 deaths each year.

4. False. Direct medical costs are about 16 billion dollars with an additional 37 billion in indirect costs related to increased morbidity, disability, and premature deaths.

6. False. One-third of all ex-smokers gain on average three to seven pounds due to changes in the way their bodies metabolize food. An individual would need to gain 70 pounds to equal some of the harmful physical effects of smoking.

8. False. When an individual is still smoking the "cough" loosens mucous which protects the lung and consequently exposes the lung to infection and cancer causing agents.

True. When an individual is not smoking the "cough" is an attempt by the lungs to heal in the absence of chemicals.

10. False. The amount of healing that the body will undergo after cessation of smoking depends on the amount and type of damage that has been done as well as your own individual risk factors for certain diseases.

12. False. With each cigarette that you inhale you take into your bloodstream thousands of poisons. Many of these are cancer-causing agents. The inhalation of these substances plus your genetic predisposition may cause multiple illnesses.

14. False. A recent study has found that approximately 17 percent of lung cancer cases in non-smokers can be attributed to their exposure to cigarette smoke when they were children.

16. False. The majority of smokers who relapse report that they felt they could have just one cigarette without harm. However, the one cigarette will generally lead to one more and over varying time periods most smokers find themselves smoking approximately the same amount.

20. False. In addition to bad breath and brown teeth, smokers are also at risk for developing cancer of the mouth, tongue, lips, and pharynx. Each year, more than 8,350 people in the United States die of oral cancer directly related to tobacco.
This Smoking Quiz is reprinted with permission from the Stop Smoking Workbook, New Harbinger Press. (There is not a return link from the New Harbinger Website)

Dr. Steven Resnick, the Coordinator of this Website and his Psychiatric Practice.
Depression Central, a "clearing house" for depressive and mood disorder information for a lay and professional audience.
National Institute of Mental Health, contains information about programs and clinical updates from this federal agency.
National Alliance for the Mentally Ill, An organization devoted to patient advocacy and public education about mental illness
Obsessive Compulsive Foundation, a good resource for information and support about Obsessive compulsive Disorder.
the Sunbox Company, Manufacturers of Light Boxes, used in treating Seasonal Affective Disorder(SAD, "the Winter Blues"). A useful link with information about SAD and it's treatment.
U.S. National Library of Medicine Home Page